Venous Collateral Blood Flow Assessed by Doppler Ultrasound after Unilateral Radical Neck Dissection

Abstract

Removal of the internal jugular vein (IJV) in unilateral radical neck dissection (rND) necessitates redirection of cerebrovenous blood to collateral pathways. If adaptation is insufficient, neurologic sequelae develop that are due to impaired venous drainage and increased intracranial pressure. The authors studied venous hemodynamic effects of unilateral rND using Doppler and duplex ultrasound in 17 patients. Blood flow velocities (BFVs) were recorded from the distal IJV (dIJV) and the vertebral vein (VV) before and 9 to 88 days after surgery. A preoperative compression test of the dIJV was performed to identify the side of dominant drainage. The BFV increased in the contralateral dIJV after right-sided rND (n = 10) by 111% (range, 50% to 320%), and after left-sided rND (n = 7) by 34% (range, 5% to 105%). In the contralateral VV, a rise of BFV by 75% was found. Our results confirm the role of the contralateral dIJV as the predominant collateral pathway. The VVs serve as an important additional major outflow. Doppler ultrasound may help to identify patients at risk of insufficient cerebrovenous drainage after rND.

Keywords

cerebral venous system Doppler sonography internal jugular vein radical neck dissection vertebral vein

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References

Corgill

. Complications of neck dissection. In: Conley

Cancer of the head and neck. London, England: Butterworth & Co Ltd, 1967: 191–201.

Gius

Grier

. Venous adaptation following bilateral radical neck dissection with excision of the jugular vein. Surgery 1950; 28: 305–21.

Doepp

Hoffmann

Einhäupl

Valdueza

. Normal blood flow velocities in the distal jugular vein and response during compression of the contralateral internal jugular vein [Abstract]. Cerebrovasc Dis 1998; 8(suppl 3): 20.

Hoffmann

Weih

von Munster

Schreiber

Einhäupl

Valdueza

. Blood flow velocities in the vertebral veins of healthy subjects: A duplex sonographic study. J Neuro-imaging 1999; 9: 198–200.

Huber

. Cerebral angiography. 2nd ed. Stuttgart, Germany: Thieme Verlag, 1982.

Shenkin

Harmel

Ketty

. Dynamic anatomy of the cerebral circulation. Arch Neurol Psychiatry 1948; 60: 240–52.

Weingarten

. Simultaneous bilateral radical neck dissection. Preservation of the external jugular vein. Arch Otolaryngol 1973; 97: 309–11.

Sugarbaker

Wiley

. Intracranial pressure studies incident to resection of the internal jugular veins. Cancer 1951; 4: 242–50.

de Vries

WAEJ

Balm

AJM

Tiwari

. Intracranial hypertension following neck dissection. J Laryngol Otol 1986; 100: 1427–31.

10.

Durgun

Ilgit

Cizmeli

Atasever

. Evaluation by angiography of the lateral dominance of the drainage of the dural venous sinuses. Surg Radiol Anat 1993; 15: 125–30.

11.

Lang

. Kopf: Teil A, Übergeordnete Systeme. Stuttgart, Germany: Springer Verlag, 1985.

12.

Fitz-Hugh

Robins

Craddock

. Increased intracranial pressure complicating unilateral neck dissection. Laryngoscope 1966; 76: 893–906.

13.

Dilenge

Perey

. An angiographic study of the menin-gorachidian venous system. Radiology 1973; 108: 333–7.

14.

Valdueza

von Münster

Hoffmann

Schreiber

Einhäupl

. Postural dependency of the cerebral venous outflow. Lancet 2000; 355: 200–1.

15.

Patra

Gunness

Robert

. Physiologic variations of the internal jugular vein surface, role of the omohyoid muscle, a preliminary echographic study. Surg Radiol Anat 1988; 10: 107–12.

16.

Royster

. The relation between internal jugular vein pressure and cerebrospinal fluid pressure in the operation of radical neck dissection. Ann Surg 1953; 137: 826–32.

17.

Weissler

Pillsbury

Complications of head and neck surgery. Stuttgart, Germany: Thieme Verlag, 1995.

18.

Jones

. Increased intracranial pressure following radical neck surgery. Arch Surg 1951; 63: 599–603.

19.

Schweizer

Leak

. A study of spinal fluid pressures in operations requiring removal of both internal jugular veins. Ann Surg 1952; 136: 948–56.

20.

Marr

Chambers

. Pseudotumor cerebri syndrome following unilateral neck dissection. Am J Ophthalmol 1961; 51: 605–11.

21.

Tobin

. Increased cerebrospinal fluid pressure following unilateral radical neck dissection. Laryngoscope 1972; 82: 817–20.

22.

Dulguerov

Soulier

Maurice

Faidutti

Allal

Lehmann

. Bilateral radical neck dissection with unilateral internal vein reconstruction. Laryngoscope 1998; 108: 1692–6.